Ishida Hirotaka, Fukutomi Toshiaki, Taniyama Yusuke, Sato Chiaki, Okamoto Hiroshi, Ozawa Yohei, Onodera Yu, Koseki Ken, Unno Michiaki, Kamei Takashi
Department of Surgery Tohoku University Graduate School of Medicine Sendai-shi Miyagi Japan.
Ann Gastroenterol Surg. 2023 Nov 20;8(2):234-242. doi: 10.1002/ags3.12754. eCollection 2024 Mar.
Anastomotic leakage after esophagectomy is a common complication. Laser Doppler flowmetry (LDF) can quantitatively evaluate the blood flow in the gastric conduit.
A total of 326 patients who underwent thoracoscopic/robot-assisted esophagectomy followed by gastric conduit reconstruction and end-to-side anastomosis were enrolled. We divided the gastric conduit into zones I (dominated by the right gastroepiploic vessels), II (dominated by the left gastroepiploic vessels), and III (perfused with short gastric vessels). Before pulling up the gastric conduit to the neck, LDF values were measured at the pylorus, the border between zones I and II (zone I/II), the border between zones II and III (zone II/III), and the gastric conduit tip (tip). The blood flow ratio was calculated as the LDF value divided by the LDF value at the pylorus.
Anastomotic leakage developed in 32 of 326 patients. Leakage was significantly associated with the blood flow ratio at the tip ( < 0.001), but not at zone I/II, zone II/III, and the anastomotic site. The receiver-operating characteristic curve analysis identified an anastomotic leakage cutoff ratio of 0.41 (at the tip). A multivariate Cox analysis showed that a blood flow ratio <0.41 at the tip was an independent risk factor for anastomotic leakage ( < 0.001).
Anastomotic leakage after esophagectomy was significantly associated with the blood flow ratio at the tip of the gastric conduit. Preservation of the blood supply to the tip via the gastric wall might contribute to a decreased incidence of anastomotic leakage.
食管切除术后吻合口漏是一种常见并发症。激光多普勒血流仪（LDF）可定量评估胃管中的血流。
共纳入326例行胸腔镜/机器人辅助食管切除术并进行胃管重建和端侧吻合的患者。我们将胃管分为I区（以胃网膜右血管为主）、II区（以胃网膜左血管为主）和III区（由胃短血管供血）。在将胃管提拉至颈部之前，于幽门、I区与II区交界处（I/II区）、II区与III区交界处（II/III区）以及胃管顶端（顶端）测量LDF值。血流比计算为LDF值除以幽门处的LDF值。
326例患者中有32例发生吻合口漏。漏出与顶端的血流比显著相关（<0.001），但与I/II区、II/III区及吻合部位无关。受试者工作特征曲线分析确定吻合口漏的临界比值为0.41（在顶端）。多因素Cox分析显示，顶端血流比<0.41是吻合口漏的独立危险因素（<0.001）。
食管切除术后吻合口漏与胃管顶端的血流比显著相关。通过胃壁保留顶端的血供可能有助于降低吻合口漏的发生率。
